Provider Demographics
NPI:1770793713
Name:FRESENIUS MEDICAL CARE
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-423-8833
Mailing Address - Street 1:9730 S WESTERN AVE
Mailing Address - Street 2:SUITE150
Mailing Address - City:EVERGREEN PK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2814
Mailing Address - Country:US
Mailing Address - Phone:708-423-8833
Mailing Address - Fax:
Practice Address - Street 1:9730 S WESTERN AVE
Practice Address - Street 2:SUITE150
Practice Address - City:EVERGREEN PK
Practice Address - State:IL
Practice Address - Zip Code:60805-2814
Practice Address - Country:US
Practice Address - Phone:708-423-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center